Preoperative embolization in patients with metastatic spinal cord compression: mandatory or optional?

Area of Science:

• Neurosurgery
• Interventional Radiology
• Oncology

Background:

• The clinical significance of preoperative embolization for reducing intraoperative blood loss in metastatic spinal cord compression (MSCC) patients remains unclear.
• Assessing the role and safety of preoperative embolization is crucial for optimizing perioperative outcomes in MSCC.

Purpose of the Study:

• To compare perioperative clinical outcomes between MSCC patients who underwent preoperative embolization and those who did not.
• To evaluate the safety and efficacy of preoperative embolization in managing intraoperative bleeding for MSCC.

Main Methods:

• A cohort of 52 MSCC patients undergoing palliative decompression were divided into two groups: embolization (E, n=18) and non-embolization (NE, n=34).
• Demographic data, neurologic status, operation time, estimated blood loss, transfusion requirements, complications, and survival were recorded and compared.
• Subgroup analysis focused on hypervascular tumors (n=23).

Main Results:

• The embolization group (E) showed significantly lower transfusion degrees (2.5 pints) compared to the non-embolization group (NE) (4.6 pints, P=0.025).
• Massive bleeding (>2000 mL) was more frequent in the NE group (10/34) than in the E group (0/18, P=0.010).
• In hypervascular tumor cases, intraoperative blood loss was significantly lower in the E group (1095 mL) versus the NE group (1988 mL, P=0.042).

Conclusions:

• Preoperative embolization effectively reduces intraoperative blood loss and perioperative transfusion requirements in MSCC patients.
• Embolization did not impact neurologic recovery, operation time, or complication rates.
• The procedure is safe and recommended for hypervascular tumors, with potential benefits for non-hypervascular tumors as well.